Vet reluctant to treat - Sweet Sasha has passed

[Ana53]

Hello everyone and thank you for allowing me to join. I have a 14 year old female lab, spayed. In the last year she has been showing signs of what I believed to be Cushings. Her urine protein was elevated, her ALK phos was elevated and her urine creatinine ratio (I think that was the test; it was a sendout) was mildly elevated but her ACTH stim was negative. She pants ALOT and she has a voracious appetite. She's always loved food (like most labs) but this is over top. She doesn't drink alot and she will maybe get up once a night to pee. The vet does not think the 8 hour Dexa test is worth doing because he said at this point it wouldn't matter because he would not recommend treating with Trilostane anyway. He said there are too many side effects and the risk/benefit ratio is not worth it. I have always had a great relationship with this vet and he knows my dog very well. But I am questioning this. Would it really be too much to put my girl through the 8 hour Dex test? She would really hate being at the clinic that long. Also, because of her age, is the vet right about the side effects? I feel like he is being dismissive. On the other hand, he said Trilostane would not cure Cushings. I really don't know what to do. We live in a small, rural town and there are not alot of options for vet clinics. I feel like seeking a second opinion would betray my vet as he would find out because our town is so small and all the vets know each other. On the other hand, I love my dog and I don't want to betray her. I would love some opinions on this. And I would also like to know if anyone has had a dog with Cushings and decided not to treat with Trilostane. Thanks very much!

[labblab]

Hello and welcome to you and your girl — we’re so glad to have you with us! I’m afraid this is going to be a busy morning for me elsewhere, so I’m unable to offer as much information as I’d like to right now. But I wanted to have the chance to at least greet you, and to let you know that your membership has been approved and that I’ll be back again later on today in order to write more.

In the meantime, once again, we’re really glad you’ve found us!
Marianne

[Ana53]

Hello and welcome to you and your girl — we’re so glad to have you with us! I’m afraid this is going to be a busy morning for me elsewhere, so I’m unable to offer as much information as I’d like to right now. But I wanted to have the chance to at least greet you, and to let you know that your membership has been approved and that I’ll be back again later on today in order to write more.

In the meantime, once again, we’re really glad you’ve found us!
Marianne

Thank you!

[labblab]

OK, I’m back again now with that lengthier reply that I promised! First of all, I am a devoted Lab mom, myself. My first boy (my avatar photo) was my beloved Cushpup who brought me to this family quite a few years ago. After he passed on, my two joys became my two non-Cushing’s Lab girls. Only one is still with me now, and she’s nearing 13 with a bright spirit but increasingly restrictive mobility issues. So my heart goes out to you on both fronts: dealing with possible Cushing’s and also just the aging issues of older big dogs.

First of all, kudos to you for providing the love and care that has gotten your girl to age 14. That is awesome! Given her age, though, my personal decision re: Cushing’s diagnosis and treatment would basically depend primarily upon her current quality of life. Are her Cushing’s symptoms making her observably uncomfortable? If not, I would likely concur with your vet and leave the Cushing’s issue alone. Rather than reinvent the wheel, I’m going to paste in a related reply that I recently posted to another member.


Given her age, Gidget has now entered her senior years. That being the case, there may be pros-and-cons to Cushing's treatment that you'd want to think over. In my own mind, the decision whether or not to treat any dog depends on a number of factors: age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen. For a younger dog, I would want to provide as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.

However, since the damage usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly. Instead, my biggest concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I might choose not to treat, especially if my senior dog suffers from inflammatory conditions like arthritis that may actually be soothed by the elevated cortisol level of Cushing's. Treatment also involves frequent vet visits and blood draws, especially at the beginning. So again, if vet visits are really stressful for a senior dog, I'd also factor that into my treatment decision.

You’ve mentioned that your girl is doing a lot of panting and exhibits the classic ravenous appetite. However, at least for now, it sounds as though she isn’t suffering from excessive thirst and urination, or other obvious symptoms of significant discomfort? If not, as I say, I’d probably be inclined to hold off pursuing Cushing’s. You know her the best of anybody, though, and if you think she’s becoming increasingly uncomfortable or compromised, then you may feel more pressure to intervene. How’s that for a wish-washy answer to your question??

I’ll go ahead and close for now, but please feel free to ask any additional questions, or just to talk over your thoughts about all this. And please know that no matter what you decide, you’ve done a great job of getting your girl to this senior stage of her life.

Marianne

[Ana53]

Thank you so much for your reply. The only symptoms my Sasha has are the panting and ravenous appetite. She has a multitude of other issues too, including spondylosis of her lower back, 2 bad knees and lots of arthritis. I never thought of the cortisol levels actually helping her! She does have a history of inflammatory bowel disease, so she is on a special diet for that. She is also completely deaf. She does not seem like she is suffering at all. She still loves her walks and of course, her meals. :-). .I think perhaps my "old timey" vet really does have her best interests at heart. I actually switched to him years ago after being with another vet( with another dog) who made me feel like I was a bad dog mom for not pursuing every possible thing under the sun, spending tons of money and putting my golden retriever through now what I see were unnecessary and futile treatments. Once again, many thanks for your thoughtful and very helpful post. I'm going to sign off now because Sasha knows its time for her afternoon walk and she is nudging me, "Let's go, already".

[labblab]

I'm going to sign off now because Sasha knows its time for her afternoon walk and she is nudging me, "Let's go, already".
Ahhh, that brings a smile to my face and also a tear to my eye. It speaks so directly to the spirit and heart of our furbabies, even in the midst of pain or hardship of their own. One of our dear members has spoken in years past about the privilege of supporting a "dog-worthy" life as long as possible, as well as our own pain when we are forced to realize that our babies' joy in living has been overcome by age or illness. As both medical and veterinary knowledge continue to advance, there are so many treatment options that emerge. But in my own mind, just because a treatment is available does not mean that it is necessarily a mercy to pursue it. It can make it so hard, though, to decide which path is truly the kindest one to follow

My own sweet girl, even with her arthritis and weakness, still twirls with excitement every morning when she sees her leash coming out and the front door opening. For a moment, she's transformed into a baby puppy once again. Once out the door, we're unable to walk very far, but it's still the highlight of our day together. I hope we'll still have many more mornings like that to savor. I surely hope that you and Sasha had a wonderful walk together this afternoon, as well.

Best wishes,
Marianne

[Ana53]

Has anyone had any success, however limited, with giving their dog homeopathic drops for Cushings? I don't think I am supposed to mention specific brands here, but I have been looking at some liquid formulations on Chewy and Amazon and wondering. They are quite pricey, which is OK if they worked at all. Sometimes my girl, Sasha, who is a 14 year old yellow lab, pants for what seems like hours, usually in the evenings. That is what I am primarily looking to help her with at this point. Thanks everyone.

[labblab]

Hello again, and welcome back! As you’ll see, I’ve taken the liberty of merging your new question into your original thread about Sasha. This way, we’re able to consolidate all the info and suggestions given for your girl in one place.

I surely do understand how wearing the panting can be for both you and Sasha. My own Cushpup seemed to pant nonstop before treatment, too :-((((. As far as the homeopathic drops, I’m guessing you may be referring to either Cushex or Adrenal Harmony Gold? If not, it’s OK for you to name what it is that you’re considering. I wish I could tell you that we’re aware of a non-Rx supplement that truly has the capacity to effectively lower cortisol levels and relieve symptoms longterm, but I’m afraid we’re not. Here’s a related reply that one of our other staffers, Lori, has written in the past.


Unfortunately I don't know of any truly effective holistic/alternate substitutes to the Rx medication when one wants to lower cortisol levels significantly. Having said that, if clinical symptoms are not that bothersome to the dog or owner, some members have told us that Cushex and Adrenal Harmony Gold worked very well in controlling symptoms but only for a short time period. Now, Cushex and Adrenal Harmony Gold have no controlled clinical testing whatsoever to back up their claims (we know this because we have contacted the manufacturers and we have been told that no testing has been done).

As far as I know, the lack of any genuine clinical testing data for these supplements remains the case. So the only thing you can rely on are the anecdotal testimonials that people provide, for good or for bad.

One other thought does occur to me in the event you’d want to pursue one other Rx possibility, and that is Anipryl (selegiline). For a short time, it was hoped to be a generally effective Cushing’s treatment, but further clinical study has shown it to be effective in relieving Cushing’s symptoms in only a small minority of dogs who suffer from pituitary tumors that grow in a specific area of the gland. The drug is now more widely prescribed for dogs suffering from Canine Cognitive Dysfunction. However, you and your vet might feel as though it could be an option to try for Sasha since it carries the advantage of not needing the monitoring bloodwork associated with either Vetoryl (trilostane) or Lysodren. It does take time to give it a trial run, however, and as I say, it only seems to be helpful for a minority of Cushpups. But it may be something you want to read a bit more about, yourself. Here’s an article to start you off. It was written back in 2001 but updated in 2019, so hopefully the info remains current:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951436

And if there is another supplement you are wondering about, you can go ahead and name it here. Perhaps one of our members will recognize it and have some feedback to offer.

Marianne

[Ana53]

Hello again, and welcome back! As you’ll see, I’ve taken the liberty of merging your new question into your original thread about Sasha. This way, we’re able to consolidate all the info and suggestions given for your girl in one place.

I surely do understand how wearing the panting can be for both you and Sasha. My own Cushpup seemed to pant nonstop before treatment, too :-((((. As far as the homeopathic drops, I’m guessing you may be referring to either Cushex or Adrenal Harmony Gold? If not, it’s OK for you to name what it is that you’re considering. I wish I could tell you that we’re aware of a non-Rx supplement that truly has the capacity to effectively lower cortisol levels and relieve symptoms longterm, but I’m afraid we’re not. Here’s a related reply that one of our other staffers, Lori, has written in the past.



As far as I know, the lack of any genuine clinical testing data for these supplements remains the case. So the only thing you can rely on are the anecdotal testimonials that people provide, for good or for bad.

One other thought does occur to me in the event you’d want to pursue one other Rx possibility, and that is Anipryl (selegiline). For a short time, it was hoped to be a generally effective Cushing’s treatment, but further clinical study has shown it to be effective in relieving Cushing’s symptoms in only a small minority of dogs who suffer from pituitary tumors that grow in a specific area of the gland. The drug is now more widely prescribed for dogs suffering from Canine Cognitive Dysfunction. However, you and your vet might feel as though it could be an option to try for Sasha since it carries the advantage of not needing the monitoring bloodwork associated with either Vetoryl (trilostane) or Lysodren. It does take time to give it a trial run, however, and as I say, it only seems to be helpful for a minority of Cushpups. But it may be something you want to read a bit more about, yourself. Here’s an article to start you off. It was written back in 2001 but updated in 2019, so hopefully the info remains current:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951436

And if there is another supplement you are wondering about, you can go ahead and name it here. Perhaps one of our members will recognize it and have some feedback to offer.

Marianne

Yes, the drops I'm considering are the Adrenal Harmony Gold. We are going to start Sasha on Anipryl next week. We had good luck with that for my 15 year old black lab who had canine cognitive dysfunction. It provided him with a few months of relative peace before he passed last year. Maybe Sasha will be in the small percentage of dogs that can benefit from it. I bought a portable air conditioner and found that Sasha likes resting right underneath it, so I direct the flow right on her and the coolness seems to soothe her. Anyway, thanks for your very informative reply. It's very much appreciated!

[Ana53]

Not sure if I should post this as a reply to my first thread or start a new one here. We stopped Sasha's Doxepin that she was getting for her presumed laryngeal paralysis and started her on Anipryl after a brief washout period that the vet prescribed. We are going on day 10 of Anipryl now and she seems so much worse with almost nonstop daytime panting and what I call "senile" barking when she can't see us (she's completely deaf) and the spark in her eyes is not there . I know it takes weeks for Anipryl to work for the small percentage of Cushing's dogs and for her also presumed cognitive dysfunction, if it will, but I don't think she can last that long being so distressed with the panting and barking. I called the vet to see if we should stop the Anipryl and go back on the Doxepin. Was told he would call me tomorrow. I feel like we are reaching the end of the road here. My gut feeling is that the Anipryl does not agree with her and at least the Doxepin calms her down somewhat. My husband thinks we should stop everything for several days and reevaluate what her quality of life is then. Guess I'm just reaching out for what your thoughts are,:(:( and just venting a bit. Thanks all.

[labblab]

Hello again, and I’m so sorry that you don’t have better news to share. As you’ll see, I did go ahead and merge your new post into your original thread. This way, we can trace back through Sasha’s entire history and view the whole big picture.

Doxepin is not a medication with which I’m familiar, so I just now did a quick Google search and one of the first articles I pulled up is this brand new study that found *no* value in using it to treat Labs suffering from laryngeal paralysis:-(((((.

https://pubmed.ncbi.nlm.nih.gov/33998727/

However, at this point, the main benefit for Sasha may just be its overall calming influence, anyway. And if she seemed to be doing better on that prior to starting the Anipryl, I’d also be inclined to just ditch the Anipryl and revert back. You’re so right that immediate quality of life seems to be of paramount importance. You may need to do another wash-out first, though. Even if not, it might be helpful to follow your husband’s suggestion and see how she does if she’s totally off everything again for a couple of days. If she stays bad or even worsens, and then she does improve again after restarting the Doxepin, you’d have greater confidence that the drug is truly beneficial in some way. But of course that means having to watch her suffer in the meantime if she does stay bad. That would be hard for me, too.

I’m so sorry that I don’t have any great suggestions for you guys. You’re really in a tough spot, that’s for sure. But please do let us know what you decide and how things develop. We’re definitely here to lend an ear even if we can do nothing else to really help :-(((.

Sending healing thoughts to you all,
Marianne

[Ana53]

Thank you, Marianne. We have decided to take Sasha off the Anipryl and maybe not even start the Doxepin again. We have been going on and off with the Doxepin for several months, and as the article points out, there doesn't seem to be any benefit to it for her. I have increased her gabapentin to 3 a day; maybe that will help calm things down.I will discuss all this with the vet when he calls today but we have decided to give Sasha a happy weekend, if we can, take her on her walks , give her all her favorite treats and let her eat all the delicious things that she finds in the backyard, like ants and tasty wads of grass. We will re evaluate Monday, and if things get too bad before then,well, we'll see. She's had a long and happy life and I don't want the end of her life to be miserable. I hold the firm belief that I will see all my furry family again on the other side.

[labblab]

I totally understand and endorse your plan. I’ll surely be thinking of your family throughout the weekend and wishing you all peace and comfort. And also love in abundance, although I know you’ve already got that part 100% taken care of.

Please give Sasha a big hug for all of us, and know that we’ll be right here for you and your husband any time that you may need us.

With my warmest wishes,
Marianne

[Ana53]

Thank you and bless you. I will update on Monday.

[Ana53]

Sasha had a bad weekend, with her panting, barking now becoming whimpering and crying, we came to the sad decision of having her put to sleep Monday afternoon. Her symptoms seemed to escalate through the weekend; she had trouble getting up and seemed confused and sad. The look in her eyes told us it was time. She had a very peaceful passing . She went for a few walks and had lots of treats with all her favorite foods. The house seems empty now but I know she was suffering and now she is not. We hope to see her again on the other side. Thank you for all your concern, advice and empathy.

[Joan2517]

I'm so sorry for your loss of sweet Sasha. The quiet is so loud when they leave us. I still listen for my Lena sliding on the floors and the way it sounded when she would push the kibble around in the bowl. Many, many hugs to you...

[Ana53]

Thank you, Joan. You are right. The quiet is deafening.

[labblab]

Oh my, I'm just so sorry, too. I know you made the merciful decision for Sasha, but at such a price for your own heart. Thank you so much for coming back to let us know, though. We're also mourning the loss of Ambro here, who passed on to the Bridge just a couple of days before Sasha. But now I'll choose to think of the two of them playing together, healthy and whole once again. And we'll always be here for you if you want to return to us to talk, or to vent, or to share stories about Sasha.

Sasha has now also joined Ambro on our special memorial thread of honor:

https://www.k9cushings.com/forum/showthread.php?9294-Remembering-All-Who-Have-Left-Us-(2020-2021)

If you should ever wish to have us link a photo of Sasha to her memorial line, you can just let me know and I'll tell you exactly what you need to do. In the meantime, please know that you and Sasha will forever remain a part of our little K9C family.

Sending you wishes of peace and comfort from across the miles, always in loving memory of your sweet girl.
Marianne

[Ana53]

Oh, so sorry about Ambro. Yes, I like to think the same thing. All the dogs that have passed on, playing and running, whole and young again. Sending you peace and love,

Ana